Your team already knows the gap list. Pelica closes it.
Your people stay on what only people can do: the member relationship, the clinical judgment, the hard call. Pelica takes the rest. Voice AI works the pharmacies and prescribers, the follow-ups close themselves, and every task routes to the right person automatically. Same team, far more members covered.
96%+
medication adherence
70%+
TRC gaps, 30 days
2–3×
members, same team
The work is fragmented
long before the people are.
Risk-bearing teams don't lose dollars because they're slow. They lose them because the data, the work, and the revenue all live in different places.
The gap list never arrives clean.
A dozen opportunity reports land in different formats, on different cadences, with different columns. Stitching them into one actionable worklist eats the hours your team should spend on members.
~12 spreadsheets per problemQuality and pharmacy work in the dark.
Quality, pharmacy, and care management run off separate files, so the same member gets called three times in a week, sometimes in a language they don't speak.
3× outreach to one memberEverything is retrospective.
Adherence slips and Stars gaps surface at quarterly reconciliation, after the window has closed. There's no capacity left to be proactive.
Caught at quarterly reconciliationTwo kinds of work.
Only one needs a person.
Your team trained to take care of members, not to leave the same voicemail twice or reconcile a spreadsheet. Pelica draws the line in the right place, then holds it.
The work only a person can do
- Building trust with the member on the phone
- The clinical judgment call on a complex case
- The intervention that actually changes someone's care
Everything that shouldn't need one
- Calls the pharmacy and prescriber, follows up until it's resolved
- Writes the perfect call note in seconds, hands-free
- Routes every task to the right person by language, skill, and urgency
- Unifies claims, EHR, pharmacy, lab, and ADT into one live record
One canonical record.
Every workflow. Real-time.
Three layers, each addressable on its own. Deployed together, the equivalent of 8 to 15 point vendors in a single platform.
Live data
Claims, EHR (FHIR/HL7), pharmacy (PDE), labs, ADT, telephony recordings, and payer SFTP drops, unified into one canonical record per member. Built for ECDS volumes. Tenant-isolated, BAA-covered, encrypted end to end.
The AI workforce
A copilot per role, plus a cross-cutting AI Data Analyst. Agents take the rote work (the calls, the follow-ups, the documentation), route each task to the right person by language, skill, and urgency, and surface only the cases that genuinely need a clinician's judgment.
Action
Outbound voice (TCPA-compliant, multilingual) calls members, pharmacies, and prescribers, follows up until resolved, and escalates to a human only when needed. Then it writes the call note automatically, in seconds.
A copilot that does the work
your team can't get to.
A small team owning 50,000–150,000 members can't close the gap by adding two more coordinators. Pelica scales the team you already have.
Get the work done after the gap list.
The gap list was never the hard part. It's everything after it. Pelica's agents make the calls, follow up, and close HEDIS and Stars gaps before the deadline, so your quality team spends its time on members instead of stitching spreadsheets.
- ~90%of BCS and KED gaps closed in-year
- 70%+of transitions-of-care gaps closed within 30 days
- 2–3×more members covered by the same team, with agents handling the legwork
Voice AI works the phones. Your techs work the members.
Pelica calls the pharmacy and the prescriber, leaves the voicemail, and follows up until it's resolved. It escalates to your techs only when a human is truly needed, then writes the call note automatically, in seconds.
- 96%+medication adherence
- PDC lifton the three triple-weighted measures: diabetes, RAS, statins
- ~10 hrsa week back, per tech, with the routine calls off their plate
Live with the largest
IPA in the country.
Delivered at HealthCare Partners, a physician-led IPA managing 200,000 lives across 1,000 providers, and live within two weeks of signing.
30 min → 3 min
Human effort per member. Agents handle the calls, the follow-ups, and the notes; your team steps in only for the cases that need judgment.
200,000
Lives managed live on Pelica across 1,000 providers, at the largest IPA in the country.
2 weeks
From signing to the first copilot live and in production. No six-month rollout.
100%
Adoption across the quality and pharmacy teams, with high repeat usage every week.
What the team does now
that the busywork is gone.
Not a pilot and not a slide. The operators at our flagship IPA, on what changed once the routine work stopped landing on their desks.
I'm no longer sitting behind a computer doing Power Queries for hours every week. Now the team can focus on building those conversations with members, the targeted interventions that actually make a difference.
Now my team can fully be present and focus on the call. The AI just makes the perfect note for them, so they can move to the next member quicker.
Our care and quality teams spend much more time on the phone with the member, addressing the concerns that actually need a person.
Built for healthcare's highest compliance bar.
Tenant isolation, encryption end-to-end, full audit trail, and contractual zero-retention with every LLM provider in use. Available on request: SOC 2 Type II report, BAA template, subprocessor list, pen-test history.
Visit our Trust Center →
Quality & pharmacy leaders ask us this.
“Pelica felt like an extension of our team. You don't just get software, you get partners.”
Alex Wiggall
SVP, Quality & Clinical Revenue Integrity · HealthCare Partners
See Pelica on data that looks like yours.
30-minute walkthrough. We'll run the Quality & Pharmacy copilots live on a redacted book of business from a real risk-bearing org.
Book a Demo →